Bed Rest

"I would encourage women with HG to be upright rather
than flat when resting and to get on their feet as much as
possible. Some weight bearing on their bones and muscles
is good so their muscles don't get weak (i.e. atrophied).
This means walking around the room or standing with weight
on their feet for at least five minutes once an hour or every
two hours for 10 minutes. Currently, I know of no research
that supports the use of severe activity restriction (bed
rest) for treating HG. While these women may find resting
helpful, in order to prevent muscle weakness and weight loss,
it would be wise to walk around the room as suggested above."

Having hyperemesis typically means at least a few weeks
of laying down for much if not all of the day. For some women,
it can last months, especially if effective medications are
not given in sufficient doses. Few understand the incredible
impact extended bed rest can have on a woman psychologically
and physiologically. The research on adverse affects is limited
for pregnant women, and even less for women with hyperemesis.
Unfortunately, many health care professionals are not aware
of the debilitating effects, especially when the woman is
also suffering from dehydration and malnutrition. Not only
do these women become depressed and lethargic, but they quickly
lose muscle mass and body weight which can deplete their
energy and result in significant pain. This can complicate
the course of HG and may contribute to its severity. The
resulting sequelae may affect both the mother and baby during
pregnancy, and will often continue to affect the mother postpartum
by prolonging recovery.

Some women receive physical therapy
(PT) during pregnancy and derive some benefit. Others receive
no therapy during
or after pregnancy and struggle with chronic pain and discomfort
for months that could potentially be minimized or eliminated.
Ideally, a woman would receive a PT consult on her first
admission for rehydration or when weight loss exceeds 5-10%,
and then be reassessed with each admission, including delivery
if HG lasted into late pregnancy. This would potentially
lessen the impact of inactivity, provided the prescribed
care was realistic and implemented by the mother. At a
minimum, simple exercises should be taught to the mother
to maintain
muscle tone and flexibility as much as possible. Every
effort should be made to keep her symptoms as controlled
as possible
to maximize her mobility and energy levels. Early intervention
to minimize the nausea and control vomiting can potentially
prevent complications and the need for extended bed rest.

Families experienced difficulty assuming maternal responsibilities, anxiety about maternal-fetal outcomes, and adverse emotional effects on the children. Child care was managed by various people across time. Child care problems included negative reactions from the children, concern about the quality of the provider, and maternal worry about care. Families also experienced financial difficulties, the majority of which were not compensated by insurance or work benefits. Almost all, 96.6%, families received some type of support during bed rest. Instrumental support was the most commonly received; however, emotional support was considered the most helpful. The least helpful type of support was that which was unreliable. The primary providers of support to the family were parents and family, followed by friends. The women reported that health care providers offered minimal support to the family.

Bed rest had a significant emotional and social impact on pregnant women and their families in both settings. Overall, bed rest in hospital seemed to be associated with more sources of stress than at home. In hospital, women had to cope with separation from home and family, lack of privacy, hospital discomforts, and incompatible roommates, whereas women at home struggled with role reversal and the temptation to do more activity than was recommended. Stressors not unique to but exacerbated by hospitalization included concerns about the children, a sense of missing out, a sense of confinement and being a prisoner, boredom, feelings of depression and loneliness, and negative impact on the relationship with their partner.

Reduction of exercise capacity with confinement to bed rest is well recognized. Underlying physiological mechanisms include dramatic reductions in maximal stroke volume, cardiac output, and oxygen uptake. However, bed rest by itself does not appear to contribute to cardiac dysfunction. Increased muscle fatigue is associated with reduced muscle blood flow, red cell volume, capillarization and oxidative enzymes. Loss of muscle mass and bone density may be reflected by reduced muscle strength and higher risk for injury to bones and joints. The resultant deconditioning caused by bed rest can be independent of the primary disease and physically debilitating in patients who attempt to reambulate to normal active living and working. This symposium presents an overview of cardiovascular and musculoskeletal deconditioning associated with reduced physical work capacity following prolonged bed rest and exercise training regimens that have proven successful in ameliorating or reversing these adverse effects.

Major problems for fathers were assuming multiple roles, managing emotional responses, and caring for their partner. The major paternal worry was for the health of mate and fetus. Coping strategies included using tangible assistance; altering cognitive, behavioral, and emotional responses; and verbalizing worries. Fathers reported receiving little assistance from health care providers. CONCLUSIONS: Fathers experience extreme stress when pregnancy bed rest is prescribed for a mate. Family-centered care should include care of the partner whose mate is at high-risk. Interventions that reduce paternal worry and provide emotional and tangible support are needed.

Stressors were grouped into situational (sick role, lack of control, uncertainty, concerns regarding fetus's well-being, and being tired of waiting), environmental (feeling like a prisoner, being bored, and having a sense of missing out), and family (role reversal and worry about older children) categories. Two main mediators of stress were social support and coping. Families, friends, and professionals were perceived as sources of support. Women used coping strategies, such as keeping a positive attitude, taking it 1 day at a time, doing it for the baby, getting used to it, setting goals, and keeping busy. Manifestations of stress were evidenced by adverse physical symptoms, emotional reactions, and altered social relationships.

Bed rest therapy has various physiologic and psychosocial side effects that generally are not recognized or treated. This article provides suggestions for providing comprehensive nursing antepartum and postpartum care of the pregnant woman requiring home bed rest and her family.

Women on complete bed rest (n = 10) had greater gastrocnemius muscle dysfunction, weight loss, and dysphoria than women on partial bed rest (n = 7) or no bed rest (n = 18). Separation from family was the greatest hospital stressor. Postpartum recovery from the side effects of bed rest was prolonged and included symptoms of muscular and cardiovascular deconditioning. The severity of side effects appeared to be directly related to the degree of severity restriction.